Individual provider Active NPI

Micheal D Wank, PA-C

  • Physician Assistant
  • Sycamore, IL
National Provider Identifier
1194887240
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085003083 Issued in IL
Practice address
2111 Midlands CT
Sycamore, IL 60178-3125
Phone
(815) 758-0000
Fax
(815) 756-7130
NPI assigned
Dec 15, 2006
Last updated
Dec 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10000909A IN
Physician Assistant 363A00000X 085003083 IL Primary
Surgical Physician Assistant 363AS0400X 085-003083 IL

Addresses

Primary practice location

2111 Midlands CT
Sycamore, IL 60178-3125

Mailing address

2111 Midlands CT
Sycamore, IL 60178-3125
Phone (815) 758-0000

Other practice location 1

900 N 2nd St
Rochelle, IL 61068-1764
Phone (815) 561-7100

Other identifiers 2

IdentifierTypeStateIssuer
035958001OtherILDMERC
000000513306OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080115000719 IL Practitioner - Physician Assistant 3173525953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

1 Kish Hospital Dr
Dekalb, IL 60115-9602
Phone (815) 756-1521

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

2111 Midlands CT
Sycamore, IL 60178-3125
Phone (815) 758-0000

5 Kish Hospital Dr
Dekalb, IL 60115-9602

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085003083ILMDPhysician Assistant
10000909AINMDPhysician Assistant
085-003083ILMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Oct 1, 2020 Accepting new patients
Central Dupage Physician Group CurrentSince Oct 1, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

1952 Aberdeen Ct
Sycamore, IL 60178
Phone (815) 758-0000

2111 Midlands Ct
Sycamore, IL 60178
Phone (815) 748-8900

2111 Midlands Ct
Ste 100
Sycamore, IL 60178
Phone (815) 758-0000

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1194887240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "815-758-0000",
            "fax_number": "815-756-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "815-758-0000",
            "fax_number": "815-756-7130"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Rochelle",
            "state": "IL",
            "postal_code": "610681764",
            "country_code": "US",
            "telephone_number": "815-561-7100",
            "fax_number": "815-754-4715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANK",
        "first_name": "MICHEAL",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000909A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003083",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-003083",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "035958001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000513306",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

Verify at the official NPI Registry.